Combination Pharmacotherapy for Stopping Smoking

Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Drugs (Impact Factor: 4.34). 04/2010; 70(6):643-50. DOI: 10.2165/11536100-000000000-00000
Source: PubMed


Globally, tobacco kills almost 5 million people around the world annually. Seven first-line pharmacotherapies are currently available and recommended by the United States Public Health Service (USPHS) clinical practice guideline for treating tobacco dependence, all of which have been proven to be effective for increasing tobacco abstinence rates when used as monotherapy. However, not all smokers are able to quit with single-drug therapy. Some smokers may benefit from combination therapy that includes the simultaneous use of different nicotine replacement therapies (NRTs) or medications with different mechanisms of action (e.g. NRT and bupropion). Combination therapy with different types of NRT may provide a therapeutic advantage by increasing serum nicotine concentrations, and combination therapy with different drugs may capitalize on synergy obtained from two different mechanisms of action. However, controversy exists regarding this approach. Available data suggests that combination therapy may increase abstinence rates compared with monotherapy. However, the cost effectiveness of this approach has not been clearly demonstrated.

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Available from: J. Taylor Hays, Oct 02, 2015
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    • "The proposed mechanisms of acute exercise differ from the process by which the nicotine lozenge exerts its effect. Combining monotherapies with distinct mechanisms of action or therapeutic pathways has the potential to yield additive-craving benefit (Ebbert et al. 2010). To date, only one study has examined the acute effects of combining exercise with an NRT product (i.e., patch) on craving (Harper et al. 2012). "
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    ABSTRACT: It is imperative that smoking cessation aids effectively alleviate cigarette craving and withdrawal symptoms because their intensity has shown to predict relapse. The nicotine lozenge and a single session of exercise have both been shown to provide relief from craving for smokers who have stopped smoking. These two efficacious monotherapies have distinct mechanic pathways, and applying them concurrently may provide additive-craving relief benefit. This study aimed to examine whether an acute bout of moderate-intensity exercise provides additional craving relief to the nicotine replacement lozenge in recently quit smokers. Thirty smokers who had abstained from smoking for 15 h were randomized to either the experimental (exercise and lozenge, n = 15) or control (lozenge alone, n = 15) condition. Craving was assessed before (baseline), during (10 and 20 min), and after (10, 20, 30, and 40 min) treatment. A significant condition by time interaction effect was found for craving (F(6, 23) = 2.70, p = 0.039, Wilks' Λ = 0.59, η ρ (2) = 0.41). While both conditions demonstrated reductions in craving, the reduction was significantly greater for the experimental group. These findings demonstrate that an acute bout of exercise provides additional craving relief to the nicotine lozenge in recently quit smokers. We recommend smokers who attempt to quit employ both cessation aids simultaneously to maximize reductions in cravings.
    Full-text · Article · Feb 2015 · Psychopharmacology
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    • "Recent research shows that combinations of smoking cessation medications tend to produce higher cessation rates than do single agents (monotherapies: e.g., Fiore et al., 2008; Piper et al., 2009; Smith et al., 2009; Stead, Perera, Bullen, Mant, & Lancaster, 2008). Such findings have led to suggestions for greater use of combination pharmacotherapy (e.g., Rigotti, 2009; also see Ebbert, Hays, & Hurt, 2010). This raises the question of whether there are any groups of smokers for whom combination pharmacotherapies are not significantly effective (i.e., relatively ineffective). "
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    ABSTRACT: Combination pharmacotherapy for smoking cessation has been shown to be more effective than monotherapy in meta-analyses. We address the question of whether combination pharmacotherapy should be used routinely with smokers or if some types of smokers show little or no benefit from combination pharmacotherapy versus monotherapy. Two smoking cessation trials were conducted using the same assessments and medications (bupropion, nicotine lozenge, nicotine patch, bupropion + lozenge, and patch + lozenge). Participants were smokers presenting either to primary care clinics in southeastern Wisconsin for medical treatment (Effectiveness trial, N = 1,346) or volunteering for smoking cessation treatment at smoking cessation clinics in Madison and Milwaukee, WI (Efficacy trial, N = 1,504). For each trial, decision tree analyses identified variables predicting outcome from combination pharmacotherapy versus monotherapy at the end of treatment (smoking 8 weeks after the target quit day). All smokers tended to benefit from combination pharmacotherapy except those low in nicotine dependence (longer latency to smoke in the morning as per item 1 of the Fagerström Test of Nicotine Dependence) who also lived with a spouse or partner who smoked. Combination pharmacotherapy was generally more effective than monotherapy among smokers, but one group of smokers, those who were low in nicotine dependence and who lived with a smoking spouse, did not show greater benefit from using combination pharmacotherapy. Use of monotherapy with these smokers might be justified considering the expense and side effects of combination pharmacotherapy.
    Full-text · Article · Dec 2011 · Nicotine & Tobacco Research
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    ABSTRACT: Smoking is the leading preventable cause of morbidity and mortality in the US, and decreasing smoking prevalence is a public health priority. Patients achieve the greatest success when quit attempts involve behavioral therapy combined with pharmacotherapy. Varenicline is the most recent addition to the pharmacotherapeutic armamentarium for the treatment of tobacco dependence. Varenicline is efficacious and cost-effective. Smoking relapse and adverse treatment-related side effects may decrease medication adherence and patient satisfaction with varenicline. In the clinical setting, varenicline treatment can be optimized by reducing doses in patients who experience intolerable side effects, increasing the dose in partial responders, and providing long-term maintenance therapy for relapse prevention.
    Full-text · Article · Oct 2010 · Patient Preference and Adherence
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